Provider Demographics
NPI:1043521891
Name:TILQUIST, LAURANE (LMT)
Entity Type:Individual
Prefix:
First Name:LAURANE
Middle Name:
Last Name:TILQUIST
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 N 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-7111
Mailing Address - Country:US
Mailing Address - Phone:954-829-1860
Mailing Address - Fax:
Practice Address - Street 1:5169 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-4508
Practice Address - Country:US
Practice Address - Phone:954-829-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-27
Last Update Date:2010-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA56092173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA56092OtherSTATE OF FLORIDA